Acupuncture in Seasonal Depression

Seasonal Depression has been described only in the past decade. Author is a psychiatrist in private practice and applies acupuncture as a modality of treatment in many mental and emotional diseases with greater degree of success, except for emotional and mental symptoms from brain trauma and brain infections which need different treatment modalities. During the practice, acupuncture is given and points are chosen according to disease rather than traditional acupuncture, believing that similium exists between the disease and acupuncture point or points.[ 1] The author is of the opinion that acupuncture points are related to nucleus or nuclei of the brain. One point for this condition is described.

Seasonal affective disorder is a serious mood disorder affecting about 5% of the population. Ancient physicians including Hippocrates believed that diseases are related to seasons of the year. Most common conditions are met every day like common cold and allergies which are seasonal in their appearance. Behavior of man is no exception to this rule of nature. It has been observed for many years that depressions are seen in winter and autumn and also in summer. Depression as we recall refers to mood state, a symptom or group of clinical syndromes. Depression is a modern term coined by Adolf Meyer, whose influence in American psychiatry is great, for melancholia. Because the sustained feelings were down, he substituted the word depression for melancholia.[ 1]

It is postulated that light has a major influence on all of us and particularly on susceptible individuals who suffer from depression seasonally. Esquirol[ 2] and Kraepalin[ 3] noted a correlation between light and depression. In the last decade we have established a condition called Seasonal Affective Disorder (SAD). This should be better described as light deprivation disorder in sensitive individuals as this can occur in blind people and others with eye diseases and also occur in people who prefer to sleep late in the morning after normal sleeping period or those with defects in the receptor sites of the hypothalamus. The description of this illness is a "condition where fall-winter depressions alternate with non-depressed periods in the spring and summer." This condition is overlooked and neglected as the physicians search for other stressors of depression.[ 4]

We are part of this universe and utilize the energy provided by the universe. We are made from physics and chemistry of this universe. The human organism is a system and there are several concentric "systems" which interact with each other and with the external environment. In the human system there are several subsystems, called organs. In the organ subsystems there are elements. The subsystem involve d in seasonal depression is the brain. The element for this illness is the hypothalamus. The hypothalamus controls light, fight (emotion and mood); fuel (heat and cold); food and fun (sex drive). These are the old 5f's taught in medicine. In recent past, light was added to this list to help brain function.

The brain has numerous functions; most important for our purposes here are motor activities and sleep. There are outputs of a subsystem which we see every day, such as sleep; but they also loop back (internal feedback) and provide input to the subsystem and element (brain and hypothalamus). For example, sleep can induce or reverse the other functions of the hypothalamus just described.

Apart from internal feedback, there are also some external (environmental) sources of input. Light comes into the eyes and influences the hypothalamus. Temperature, likewise, affects various internal systems. At the same time, some of our behaviors mediate these external inputs. For example, when we sleep, we get less light; when we engage in REM sleep our temperature drops. Thus, sleeping behavior affects the nature and quality of external input into the system as light does not pass through the eyes, and at the same time temperature drops in REM sleep EEG.[ 5]

A cardinal problem in this mood disorder is failure of homeostasis. Generally external events that impinge upon the individual are accommodated by internal adjustments. But in this mood disorder, such "rebalancing becomes more difficult to achieve." Jet lag is a point in consideration: a normal individual may take two or three days to adjust after crossing several time zones, but a patient with an affective disorder may enter into manic or depressive episodes. Similar consequences result from altering sleep patterns.

Since light and temperature normally vary with the seasons, the normal environment poses a greater challenge to the internal homeostasis of an individual with an affective disorder. Thus, "seasonals" (individuals suffering from SAD) are particularly vulnerable to light deprivation and experience more severe and intense symptoms because of their relative inability to adjust.

Alfred Lewy and his colleagues in National Institute of Mental Health of the United States of America have made an exciting finding about nocturnal secretion of the hormone melatonin by the pineal gland. The secretion is known to be suppressed in animals by environmental light, but it was previously thought that human beings were not subject to similar suppression. This erroneous conclusion was a failure of the results in the less bright areas; researchers were using regular room lighting to test for suppression. Lewy, however, used a light of 2500 lux (5 to 7 times normal room lighting) and determined that, in fact, melatonin secretion was suppressed. It can be concluded that biological rhythm is regulated by light more than what we use for our daily living.[ 6]

Another area to look at is the lower animal kingdom whose adoptive mechanisms have been studied and documented. Seasonality is very apparent in Alaska, where the seasons are powerfully demarcated. A classic example is the hibernation of the bear. SAD patients describe in their statement that, "I would have been a bear because they are allowed to hibernate and humans are not. We have to get our kids off to school, and clean the bathroom, and do all things. I would not even be depressed if all these demands were not placed on me." This inclination to "hibernate" is typical of the SAD patients and part of the severe depression. The reduced melatonin makes bears sleep in the daytime and wake up at night in search of food.

Alaskan sheep have a marked degree of seasonal rhythm of reproduction. It is crucial for animals to give birth to young at a time of year when the weather is clement and food is available. This would enhance the adoptive strategy for survival of the species.

Seasonality, natural selection, and survival of the species are interrelated in the reproductive cycle of the caribou. The antlers of the caribou bulls are seasonally grown under the summertime influence of the hormone melatonin. At the end of the summer, when they have reached their greatest strength and length, they battle over the right to impregnate the cow and pass on the genes of the most powerful bulls.

The weasel experiences a seasonal change of coat color in order to blend in with its surroundings. In winter, the black weasel becomes that beautiful white creature (for which the lowly name of weasel seems inappropriate) called ermine. With so many adoptive mechanisms in the animal kingdom, it is certainly not unexpected that human beings have also developed some kind of adaptations.

Characteristics of SAD

The group is overwhelmingly female as in affective illness (a ratio of approximately five to one) with average onset in the early twenties. In Washington, D.C., depressions last, on the average, 5.1 months, generally beginning in October or November and subside in March or April.[ 5] One of my female patient's depression in southern Illinois started exactly on January 5th and ended on May 5th. In Southern California another patient whose depression started in the 3rd week of November ended in the 2nd week of February. This patient was treated with acupuncture for Unipolar Depression effectively six months before winter depression. As we all know in southern California (San Diego area) the maximum temperature in the month of January is 67 degrees F. Both female patients had seasonal depression treated effectively by acupuncture. Approximately 80% of the patients are diagnosed as depressed in the winter and hypomanic in summer; a smaller group is diagnosed as having unipolar mood disorde r.

Among those diagnosed with SAD, a euphoric or irritable "hyper" state is very common; florid mania and truly disruptive behavior in an activated state is less common. Many are chronic depressives with seasonal exacerbations. Other common characteristics include a family history of major affective disorder and/or alcohol abuse.

In the clinical setting, it is important to examine the issue of seasonality. Some patients who are not primarily seasonal nonetheless have seasonal components. They feel worse on dark days and in winter; they have a strong preference for offices with windows and for vacations in bright, sunny places. They say, "I hate winter."

A number of conditions simulate SAD. In populations studied by the medical profession, the patients are examined for reduced energy level, hypothyroidism, hypoglycemia, or chronic viral condition like Epstein-Barr virus infections. They have received psychiatric treatments ranging from antidepressants, lithium to thyroid supplements, occasional hospitalizations, and even ECT treatments. Antidepressants are not helpful for this condition. Phototherapy is also given with bright light. Effectiveness of this therapy is being researched.

The symptoms profile includes decreased activities and the expected changes in mood-sadness, irritability, and anxiety. There are appetite changes as well; carbohydrate craving and weight gain are found in almost three-quarters of patient populations. A change in sleeping pattern is observed, with earlier onset of sleep and later rising in the morning. There is decreased libido, difficulty at work and interpersonal problems are present in almost all cases. About 50% of the women have premenstrual problems which are worse in winter.

Failure of treatment led this writer to search for other modalities of treatment. An acupuncture point was chosen after a thorough research into this disease. The acupuncturist read a lot of anatomical (correspondence), physiological (fragrance), pathological (low back wonder), emotional (buried spirit), mental (great deficiency), spiritual (heavenly store house, palaces, gate, windows), spirit path (ghost), environmental (wind), seasonal (spring or kunlun mountain), and psychosomatic (abdominal sorrow) relations of the points to the bodily organs and extra personal space (ego).

Dr. Voll and his colleagues have mapped out extensively the relation of the point to organs and its various components anatomically and are able to pinpoint diseases by an electrometer. His work represents an excellent correlation of acupuncture points to the anatomy of organs and their components. Many biological practitioners of medicine in West Germany and here use German Electroacupuncture.

The use of these points described by Dr. Voll and his colleagues are limited in clinical management and treatment of mental and emotional diseases (personal communication with Dr. Voll in 1983). The acupuncture books written by master acupuncturists depict seasons, but it is almost impossible to correlate the points to the seasons. A point such as Kunlun Mountain was described in the acupuncture books. The meaning of this point is that kings and queens of China visit the area near this mountain in the springtime. The writer is certain that Chinese poets and writers have described this mountain and surrounding areas for thousands of years. I had the opportunity of visiting this area in a boat ride. The mountains look like temples and a beautiful river flows near this mountain. The views are breathtaking and the villages and the cities are far away. Such a point is Bladder 60, which is behind the external malleoli. When the needle is applied to the point, the patient feels relaxed and s miles and 50% of the depression disappears within seconds. Within tan minutes patient feels 75% improvement in her mental status. The writer has consistently used staples to enhance the continuity of the treatment particularly in chronic cases after initial treatments with an intradermal needle. As this is an affective illness, personal suggestion is to treat SAD for one year. This modality of treatment would help vast numbers of patients suffering in the winter.